PM&R Resident E-Newsletter

August 2015

A Spotlight on Paralympics and Adaptive Sports

Written by Martin Bomalaski, MD
University of Michigan
Class of 2017

Edited by Jason Leung, MD
University of Michigan
Class of 2017

In the summer of 1948, a small group of British World War II veterans came together for the first International Wheelchair Games, which later evolved into the Paralympic Games. Today, the Paralympics serve as the world’s largest stage to showcase the highest level of achievement for disabled athletes. The Paralympic Games are held every 4 years, following the Olympic Games, and are governed by the International Paralympic Committee (IPC). Paralympic games also run for both winter and summer seasons. This committee has also established 10 disability categories, including physical (e.g., impaired muscle power, loss of limb, ataxia, short stature), visual, and intellectual impairment to divide athletes. Based on these categories, the IPC now uses functional classification (regardless of medical diagnosis) to help group athletes for competition.

As physiatrists, we are especially well suited to serve the specific medical and rehabilitative needs of the Paralympian. It has likely occurred to many PM&R residents what a unique and extraordinary experience it would be to volunteer with the Paralympics. On that note, let’s meet 2 great examples of physiatrists who are deeply involved in the world of Paralympics and adaptive sports.

Dr. Blauwet completed her fellowship in sports medicine at Rehabilitation Institute of Chicago (RIC) in 2014. She has unique insight into the world of adaptive sports, both as an athlete and a physiatrist. She sustained a spinal cord injury as a young girl and later became involved in wheelchair racing. Among her many accomplishments, she has won both the Boston and New York City marathons, and is a 7-time medalist in the 2000 and 2004 Paralympic Games. She currently serves as the chairperson for the International Paralympics Committee’s Medical Committee, and practices sports medicine at Spaulding Rehabilitation.

Her advice to residents is simple: “Get involved. Adaptive sports are all around us. Countless communities across the country have adaptive sports teams. Get involved at the community level. Ask how you can help, medical or otherwise. In general, many of these teams are medically underserved and would benefit from having access to a medical provider during training and events. Learn the culture of the sport, and gradually start volunteering at larger regional and national events. From an academic aspect, find opportunities for writing and publication on topics related to adaptive sports. This is a great opportunity to develop as a physician,” says Dr. Blauwet, adding, “Seek out other physicians involved in adaptive sports who can serve as mentors. We’re a small community.”

Suzy Kim, MD
U.S.A. Paralympic Team Physician 2009-present

Dr. Kim has always been an active triathlete, but during medical school, she was in a surfing accident which resulted in a spinal cord injury. A determined Dr. Kim finished her physical rehabilitation in 10 months, returned to finish medical school, and went on to graduate residency from RIC. She continues to compete at a high level in adaptive sports.

She further served as the team physician for the U.S. Paralympic track and field team from 2009 to 2013. She reflects with enthusiasm, “I feel unbelievably blessed to work with these amazing athletes. I may be biased, but physiatrists are the perfect physicians to provide medical care unique to their respective disabilities and sports specific needs. From prosthetic related issues to unique autonomic and cardiovascular considerations, my physiatric training was invaluable.” Dr. Kim has traveled with the United States Olympic Committee (USOC) Sports Medicine Staff to the Guadalajara and Toronto for the ParaPan American Games in 2011 and 2015 as well as London for the Paralympic Games in 2012.

Similar to Dr. Blauwet, her suggestion to current residents is, “Get involved! Hopefully, for most PM&R residency programs there’s an adaptive sports program/club locally. Volunteer to provide protective equipment, and cover practices and competitions.” She also points out that the USOC website has links to local designated Paralympic sport clubs across the country. “If there are specific sports people are interested in, contact that sport’s coach.”

How does a PM&R resident get involved?

Unfortunately, physicians are not allowed to become a medical volunteer for the United States Olympic Committee until they have been practicing for at least 5 years post-residency. However, don’t let this be a discouragement. The answer lies in adaptive sports, of which the Paralympics is only one manifestation. Disabled athletes have adapted a variety of well-known sports, as well as creating some that are completely original. Almost all sports have an adapted version. For example, official Paralympic sports include archery, canoeing, judo, table tennis, volleyball, etc. A full list categorized by impairment groups can be found below in the resources section.

Steven Makovitch, PGY4 resident at the Rehabilitation Institute of Chicago, recalls that early in his residency he had an interest in getting involved but wasn’t sure how. Even at a large PM&R center such as RIC, he didn’t know what opportunities were available to him. However, Dr. Makovitch took the above advice to heart and ended up volunteering with a local wheelchair basketball team in Chicago. He not only found it to be one of the more valuable experiences during his residency, but also had a lot of fun along the way.

Even though residents cannot volunteer for the Paralympics at this stage in our career, there are plenty of opportunities in the community! It is never too soon to start supporting our local athletes. If there’s one thing that Dr. Kim, Dr. Blauwet, and Dr. Makovitch can agree on, it’s how important it is to get involved at the local level, learn the culture, find out how you can contribute, and help continue the symbiotic collaboration between PM&R and Paralympic athletes.

Be sure to lookout for the upcoming 2016 Summer Paralympics in Rio de Janeiro!

A 3 Part Series – Journey to the East: A Physiatry Resident Goes to Japan -
Research & Fun

Toshiba Acquion-One CT Scanner
with “Swaru” Chair

Charles Odonkor, MD
Graduation Year: 2017
Johns Hopkins University

Research

While I played more of an observatory role in the clinical care of patients, I was actively involved in dysphagia research under the guidance of Dr. Eichi Saitoh and Dr. Jeffrey Palmer. Previous reports suggest that the risk of aspiration is related to the amount of pharyngeal residue (material that remains in the valleculae and piriformis sinuses post swallow). However, studies with detailed 3D analysis of residue area, volume and area-to-volume relationship are lacking. Therefore, the primary objective of my research project was to measure and characterize pharyngeal residue area-volume relationship using a novel 320-detector-row multi-slice computed tomography (320-MSCT) scanner. This new modality acquires multi-phase data over a wide 16-cm region spanning the oral cavity to the upper esophagus, including multi-planar reconstruction (MPR) and 3D-images of swallowing in real time. With the help of the speech language pathologists and research team, I collected and evaluated pharyngeal residue data among thirteen patients with medullary infarction and bulbar-palsy. I hope to present some of the exciting research findings at a national physiatry meeting later this year. Throughout my time at FHU, one of the things that made an impression on me was the seamless integration of cutting edge technology in rehabilitation research. On a global scale, methods to evaluate dysphagia are limited due to reliance on 2-D images, which provide incomplete information, and do not accurately reflect 3D functional and anatomical components.

Testing the Winglet for
Balance Rehab

With its innovative 3D CT studies of swallowing, FHU is pushing the boundaries of dysphagia research and providing deeper insights into our understanding of deglutition disorders. In addition to doing swallowing research, I participated in testing and using robotized orthoses and wearable power assist locomotor devices, including the Winglet (similar to a segue with a weight suspension system) for gait/balance rehabilitation.

An emerging theme during my elective was the close-knit relationship between industry (predominantly auto/pharmaceuticals) and medicine due to the Japanese government’s more liberal policies and regulations compared to the United States. For example, through personal networks and affiliations, some universities had several unrestricted sources of funding and research grants from Toyota, a big sponsor of robotic and information technology in rehabilitation research in Japan. Although this provided an unfair competitive advantage for those with access to this type of funding, it also allowed for high-risk innovative research. Close collaborations with industry have subsequently facilitated technological transformation of rehabilitation in Japan. Moving forward, the integration of robotics for neuro-rehabilitation complements advancements in understanding of motor learning interference and motor memory consolidation.

During my time in Japan, I noticed the corollary effects of infusion of technology in the high rates of conversion of other clinical specialists (neurosurgeons, orthopedic surgeons, otolaryngologists) to rehabilitation medicine. I met three such individuals at FHU, who had converted to become physiatrists after more than two decades in their primary specialty. They told me that they felt rehab was the way of the future in Japan given the rapidly aging population, and that physiatrists made the most significant impact in terms of long-term outcomes for their patients. Technology also made “rehab cool and fun.” Overall, it was instructive to witness and learn about the transformative uses of technology in rehabilitation research.

The Kiyomizu Dera, Kinkaku-ji
Temple in Kyoto. A fish stall in
Ameyoyokocho Market in Tokyo.

Before long, the month of fun and learning came to an end. I bid adieu to newfound friends and mentors, who I know will be lifelong collaborators and with whom I hope to continue working with on global rehabilitation projects. I returned to Baltimore on March 2nd, having been touched and awe-inspired by the Omotenashi (hospitability) spirit and warmth of the Japanese culture and its people. In particular, I was moved by the ground breaking and innovative research in the field of rehabilitation medicine and the Japanese drive to make physiatry one of the premier specialties nationally and globally.

*Maintenance of Certification® (MOC®) was developed by the American Board of Medical Specialties (ABMS) to improve patient care by ensuring continuous lifelong learning and professional development throughout a physician’s medical career. For board-certified physiatrists, the American Board of Physical Medicine and Rehabilitation (ABPMR) sets MOC requirements that are customized to the specialty and ensure compliance with ABMS Standards. Recognizing that physicians participating in that process want a variety of options to meet these requirements, your Academy has developed a series of resources that satisfy the different components of MOC. All Academy tools available to help you meet MOC requirements can be found on mē®.

FREE Injured Worker Pain Management Education Available on mē®

Four online slide lectures focused on the injured worker chronic pain management and biopsychosocial treatments are now available onme®:

Join Us in Boston for Learning, Networking, and Fun!

Are you a PM&R resident looking for education and networking events tailored specifically for you? Don’t miss this year’sAnnual Assemblyin Boston, October 1-4! With approximately 500 residents attending each year, the AAPM&R Annual Assembly is the largest annual gathering of PM&R residents. Balancing the clinical with the practical, the Annual Assembly is an excellent opportunity for residents in PM&R programs to learn more about the specialty and AAPM&R.

NEW – Resident Experience on the Show Floor

Friday, October 27 am–9 am

Participate in this new residents-only sessionon the Exhibit Hall floor. This is your chance to learn directly from up to 6 companies about their products and how they affect the patients you treat in a relaxed, compliant setting. Sponsor products include ultrasound, botulinum toxins, and intrathecal therapies. There will be hands-on opportunities for some to explore and learn about products. Attendees have the option of exploring a company’s products during the remaining open Exhibit Hall hours.

Take advantage of this new experience. Attendees will be divided into 6 groups and will spend 15 minutes at each participating sponsors’ booth. Participants who visit all 6 booths will be entered to win AAPM&R giveaways, including tickets to the President’s Reception, gift cards, and more! Coffee and a light snack will be offered.

Annual Assembly Workshop Volunteers Needed

Residents–Volunteer a bit of your time—and reap the rewards! Residents who volunteer to assist with a workshop will be given complimentary access to that session and are eligible for remuneration ($100 per day for most). If you are interested in volunteering, please complete the2015 Annual Assembly Workshop Volunteer Survey!Contact theAAPM&R Meetings Teamwith any questions.

Has Your Program Registered for the 2015 PM&R Residency Fair?

Continuing an annual tradition, the Academy will be hosting a PM&R Residency Fair as part of the2015 Medical Student Program, "Understanding PM&R". This year, residency programs may sign up for a booth at no cost. This is a great opportunity for you and your program to network with the next generation of physicians and to attract the best and brightest to your residency, so be sure your program has secured a free booth! Pass along theresidency registration formto your program coordinator.

Run for Research!

The Foundation for Physical Medicine and Rehabilitation (PM&R) is again hosting their annual Rehab 5k Run/Walk & Roll event to raise awareness about the Foundation and additional funding for its research grants program. Come join your fellow residents, physicians, and members of the Boston community on Friday, October 2 at 6:30 am at the Boston Common to support this important cause. Sign up when you register for theAnnual Assemblyor onsite at the Foundation booth in the Exhibit Hall. Registration forms are also available on theFoundation's website- cost is only $15 per resident, or $20 for onsite registration beginning at 6 am the morning of the run.

Additional donation forms are also available on the Foundation’s website and there is an award for the residency program that raises the most funds and sends the most runners – just indicate which residency program you belong with on the registration form! Many of today’s researchers got their starts with seed money from the Foundation, and the Foundation for PM&R is the only organization of its kind exclusively dedicated to PM&R research and education - Come run, walk, and help support the future of physiatry.